Wednesday, May 16, 2007

Polls are open at the New England Journal of Medicine

For the first time, physicians will be asked to weigh in on what they would do for a patient, based on research papers published in the current issue and what they read about a fictitious case. Their choices will be tallied online for four weeks and their comments posted in an experiment to better connect with readers, editor-in-chief Dr. Jeffrey M. Drazen (left) said in an interview.

"We dreamed it up to engage more with our audience," he said. "We’ve been in broadcast mode and now we’ll be in receiving mode."

The answers to the poll may shed light on therapeutic decisions that physicians make every day, Dr. Richard Schwartzstein, associate chief of pulmonology and critical care medicine at Beth Israel Deaconess Medical Center, said in an interview. He was not involved in creation of the interactive poll or the studies on which this week's case is based.

"I think it’s a very intriguing idea," he said. "We know that the delay between the publication of key articles or guidelines and the actual implementation of the recommendations around the country is quite long, sometime years."

One example is the wide variation in how recommendations to prescribe aspirin after people have heart attacks are applied, Schwartzstein said.

"People have always speculated whether that’s because the publications don’t get out into the community as rapidly as you might think or whether there is skepticism on the part of many doctors for the recommendations and data upon which they are based," he said. "Or they just don’t think it applies to their patients."

First up in the Journal is the case of a 30-year-old woman with mild persistent asthma who wonders if she should change her medications. The vignette is followed by three choices and an essay to support each option. Readers can make their picks and explain why online.

The articles that prompted the exercise have clear clinical implications for the treatment of mild asthma, Drazen said. He expects there to be three or four other occasions in the coming year when the journal will open up a forum to sample what decisions might be made at the bedside or in the doctor’s office.

Clinical trials reported in scientific journals get practitioners thinking about important issues, but they don’t always relate directly to the real world, he said. Articles are more likely to give a general level of direction as opposed to specific guidance.

"Evidence-based medicine is somewhat of an illusory thing," he said. "Very few patients fit the inclusion criteria for a clinical trial. It’s like putting together a jigsaw puzzle when the pieces don’t quite fit."

Poll results from clinicians may add another piece of information about how clinical decisions are made.

"We hope to learn from them as well as having them learn from us," Drazen said.